Young Lochinvar holds firm in reshuffle outreach

Saturday night was better than Sunday night last weekend. I spent Sunday (lovely weather, so they tell me) in the dark and windowless room I share with eight others in the Palace of Westminster, trying to predict Tony Blair's reshuffle.

It took until 10pm to piece together a new fact, namely (as you now know) that Steve Byers had beaten our very own Alan Milburn into the number two job in the Treasury. Not because Mr Blair does not admire the health minister, but because Frank Dobson had pleaded to be allowed to keep young Lochinvar in this politically important post, shortening waiting lists.

David Blunkett, one inferred, had pleaded less hard for the schools minister. Such was the spin anyway. Prime ministers, even Maggie Thatcher, hate butchery and say nice things to the disappointed. Alan Milburn and Tessa Jowell were among those thus reassured.

Next time, maybe. But Margaret Jay was promoted to Leader of the Lords.

On Saturday night the Whites spent an evening entertaining a clutch of my Antipodean in-laws, who happen to include a globe-trotting pharmaceutical chemist, a brace of hospital consultants and a UK-based professor of medicine. My UK and New Zealand-based cousins traded sharp verbal blows over The Guardian's report that ministers were to launch a post-care in the community strategy for mentally ill people this week.

'If they're dangerous to the public, they should be locked up,' said one of our medical crew, rattling off statistics about Christopher Clunis- style killings.

Whereupon the consultant psychiatrist among us launched into a explanation of just how unjust that would be to the vast majority of schizophrenia patients and others now released from long-stay hospitals.

These are the kind of people who are going to get what ministers, ever fond of adopting other people's jargon, are now calling 'assertive outreach' programmes, funded from between 500m and 1bn of the 21bn of the mega- dosh that Citizen Frank obtained from Gordon Brown. Tory health ministers had been promised the cash from the closure and sale of the old 'water tower' psychiatric hospitals, but never got it.

Talking to ministers in several departments before the reshuffle details emerged, I had been struck by the use of Blairite language. They talk of 'outcomes' for the framework which Professor Graham Thornicroft's new committee will produce. That means equality of standards (a centralising formula, I'd say, though diverse delivery mechanisms will be tolerated) since Mr Dobson is keen on fairness.

But it also means outcomes measured in terms of 'value added' - more buzz words - both to the lives of vulnerable people who need attention and to the peace of mind of those they might attack if they don't get that attention. No more letting people fall through the gaps. Junior health minister Paul Boateng has visited the Pathfinder project in south London, as well as schemes in north Birmingham and in Oz, and been impressed with multidisciplinary teams' success at keeping in touch with patients.

As it happens, I have a Kiwi in-law, who has lived in a sheltered hostel for years and needs medication to stabilise his life. (The Capitol Hill gunman had, by contrast, it is said, stopped taking the tablets.) Yes, this does mean more beds for mentally ill people, though not necessarily acute beds in hospitals, but hostel beds, respite beds and the like.

In New Labour-speak all this translates as mentally ill people having responsibilities as well as rights: a duty to take their medicine. If not, assertive outreach will come and find them. It will come armed with a new mental health act, which will permit action against non-compliance by those who are not detained under the wing of the Mental Health Commission.

'Their most important right is not to be lost and forgotten in the system, but the right to be cased for,' I was told. There's a muscular Blairism to that phrase. Indeed the PM is himself a bit of an assertive outreacher to us all. I feel sure my ministerial source will prosper. Though not this week.

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